As a general rule of thumb, you should administer the lowest dose and the simplest
treatment first. This is just a guide. Your situation could be different. Always check
with your doctor before taking any medication or before discontinuing any medication you
are already taking.

The number of women suffering from these conditions is increasing. It is influenced by
excess stress, poor diet, environmental factors, and drug use, including taking birth
control pills. Typical person suffering from this condition is in the early to late
thirties to early forties. They may have generally regular periods but still suffer from
symptoms associated with menopause.

In the case of PMS, many of the symptoms associated with it (such as bloating,
headaches, anxiety, etc.) are the same as what is labeled for older women close to the
cessation of menstruation "estrogen dominance.'

Basic Protocol for PMS

Take a progesterone cream or oral micronized progesterone. The most common prescription
is 25 to 100 milligrams.

Take this as follows:

Starting on day 14 of your menstrual cycle (or the day after ovulation), apply

1/8 teaspoon of cream on days 14 to 17

then ¼ teaspoon on days 18 to 22

then 1/2 teaspoon of progesterone cream until the start of the menses

and then stop.

Start again next month at the same time.

The cream may be applied on your wrists, inner arms, stomach, thighs, or neck. After
three, and usually within six, months of regular use you will notice that your symptoms
are less pronounced.

You can then start your progesterone treatment when your first symptoms come at any
time in the month. Usually, by this time they are less severe and less frequent, if not
completely gone.

If symptoms disappear completely, stop treatment and use again if they return.

Basic Protocol for Premature Menopause

Approximately 8 percent of the women stop having their periods before forty. Typically,
these women are treated with birth control pills, which means that they are being given a
progestin to control symptoms.

Black Cohosh Herb  standardized extract

You may experience relief from symptoms quickly, but therapeutic effects will be better
evaluated after four weeks of treatment and thereafter; the longer the duration of
treatment the greater the rate of improvement.

and/or

Progesterone:

Take a progesterone cream or oral micronized progesterone. The most common prescription
is 25 to 100 milligrams.

Take this as follows:

Starting on day 14 of your menstrual cycle (or the day after ovulation), apply

1/8 teaspoon of cream on days 14 to 17,

Then ¼ teaspoon on days 18 to 22,

Then 1/2 teaspoon of progesterone cream until the start of the menses,

And then stop.

Start again next month at the same time.

The cream may be applied on your wrists, inner arms, stomach, thighs, or neck. After
three, and usually within six, months of regular use you will notice that your symptoms
are less pronounced.

You can then start your progesterone treatment when your first symptoms come at any
time in the month. Usually, by this time they are less severe and less frequent, if not
completely gone.

If symptoms disappear completely, stop treatment and use again if they return.

Given time, the herbal products combined with supplements are often sufficient, and
progesterone can be added during times of added stress. Because the herbal regime takes
effect more slowly, those women who want relief more quickly can turn directly to the
natural progesterone.

An average women go through a stage called perimenopause between age forty-five to
forty-niners. This stage is characterized by wildly fluctuating estrogen levels. Their
symptoms can be similar to those of menopausal women, but they are still menstruating. The
focus on whether or not to replace estrogen as the sole criteria for treatment creates a
blindness to other factors causing 'menopausal' symptoms, and because standard
practitioners don't usually have herbal remedies and tonics in their cabinets, the
peri-menopausal woman frequently slips through the cracks of standard treatment.

Atypical example os a perimenopausal woman is described by Marcus Laux in his book
Natural Woman, Natural Menopause:

The case of Ellen D. is typical. In her mid-forties and still menstruating, she was
having very distressing symptoms: sudden weight gain, mood swings, zero interest in sex,
occasional hot flashes, insomnia, and depression. Her doctor measured her estrogen
levels--which were deemed "normal'--and declared it "too soon" for
HRT.
However, this peri-menopause period is one of so-called estrogen dominance, when a woman's
body may be producing smaller amounts of progesterone in relation to her estrogen. Ellen's
doctor didn't check her progesterone levels, or look for an underlying cause for the
symptoms. He just sent her home and told her to live with it. She is just "that
age."

So Ellen tried to help herself the best she could. She dieted strenuously to combat the
weight gain, which didn't go away. She took sleeping pills for the insomnia. Still, she
felt awful. Her frustrating search went on for several years; it was only when she began
to use a progesterone cream under Dr. Laux's care that she was able to deal with what were
symptoms of estrogen dominance-wild fluctuations of estrogen in relation to unbalanced
progesterone levels.

Some of these women may also be prescribed estrogen unnecessarily. Giving estrogen to
these women can only add to their symptoms of "estrogen dominance." They should
be treated with progesterone to which they respond very well. The progesterone balances
the estrogen's effect. And, as a pre- cursor hormone, progesterone can convert to estrogen
in a woman's body over time, if there is a need for it. For the peri- menopausal woman
this can definitely be the best first line of treatment.

Basic Protocol

Black Cohosh herb standardized

and/or

Progesterone: 25 to 200 milligrams daily in divided doses (oral). You
can also use an equivalent cream. If your symptoms are intense, you can take this dose
continuously throughout the month. After 1 to 3 months most women feel more hormonally
stable; then take your progesterone cyclically for 12 days, starting at what would be the
middle of your normal cycle. You can stay with your continuous progesterone treatment if
your symptoms dictate this, or you can use a cyclic approach that mimics your body's
wisdom once your system and symptoms are stabilized.

If your symptoms aren't alleviated with just progesterone therapy, or if your lab tests
indicate that you need estrogen then take:

Tri-est and progesterone: 1.25 to 2.50 milligrams total estrogen. A
dose of 1/2 teaspoon of tri-est cream plus progesterone equals 2 milligrams of total
estrogen (1.6 milligrams estriol, 0.2 milligram estrone, 0.2 milligram
estradiol) and 25
to 100 milligrams of progesterone. Apply this dose twice daily, morning and evening,
throughout the month. You can use this for twenty-five days on and five days off, or you
may use it continuously, straight through the month.

If you have had a complete hysterectomy, then you need to have a complete panel of
tests to determine your hormonal needs. This includes estrogen, progesterone, DHEA and
testosterone. These hormones affects functions of the body other than just your sex
function. An example is brain function. The objective here is to provide a complete
hormonal balancing.

A thorough hormone replenishment program can improve the energy, memory, sex drive, and
overall immunity. The common practice is to give these women just estrogen. The logic is
that since they dont have their ovaries, they do not need progesterone. Many
doctors, however, feel that this is not s sound practice. They point out that these women
sometimes undergo severe side reactions that can be relived by adding progesterone to
their hormones. Natural progesterone has protective and balancing effects throughout the
body. For example, it can limit water retention and weight gain, enhance the functions of
your central nervous system, and help protect your breasts from cell changes that can lead
to cancer.

Basic Protocol

Estradiol and progesterone (oral): 0.5 milligram E2/25 to 100
milligrams progesterone two times a day, morning and evening. After approximately one
year, you can gradually move to a tri-est and progesterone formula.

Tri-est and progesterone: 1.5 to 2.50 milligrams total estrogen. A
dose of 3/4 teaspoon of tri-est cream plus progesterone equals 2 milligrams total estrogen
(1.6 milligrams estriol, 0.2 milligram estrone, 0.2 milligram estradiol) and 25 to 100
milligrams progesterone. Apply this dose twice daily, morning and evening, throughout the
month. You can use this for twenty-five days on and five days off, or you may use it
continuously, straight through the month.

Testosterone: 2.5 to 5.0 milligrams daily, orally or in a transdermal
cream. Use the lowest possible dose.

Optional:

DHEA: 5 to 50 milligrams 1 or 2 times daily, orally or in a
transdermal cream, divided doses, twice a day. Because of complications from the use of
DHEA, we do not recommend its use unless it is absolutely necessary.

Joel Hargrove, M.D., chief of the Vanderbilt Menopause Center in Nashville, Tennessee,
uses the following medical criteria to determine whether a woman is menopausal:

Estradiol levels are less than 50 picograms/milliliter;

FSH levels are greater than 50mlU/milligrams; or

You have no periods for one full year.

What you use depends on your individual needs as each person is different. The type and
number of symptoms, as well as their strength and duration, can vary. Some women have
symptoms for only a short space of time, while others struggle with menopausal symptoms
for many years.

Women using natural progesterone may experience some temporary spotting, which in
almost all cases clears up within a few months.

Basic Protocol

Black Cohosh Herbal standardized extract

Other herbal products

Use as directed on the package or by your doctor.

Progesterone: Alone, 25 to 100 milligrams--orally or equivalent dose
in a transdermal cream, in divided doses twice a day.

Progesterone cream:

days 1 to 7-do not use cream

days 8 to 21-1/4 teaspoon morning and night

days 22 to 31-1/2 teaspoon morning and night

As symptoms subside, you can gradually begin cutting back on the amount of cream used.
If the above recommendations are not sufficient, or estrogen is needed, experts recommend
using Tri-est and progesterone: 1.5 to 5 milligrams total estrogen and 25
to 100 milligrams progesterone morning and night.

The tri-est combination will work for most women, but for women who need to use the
strongest estrogen, at least temporarily use the following:

Estradiol (E2) and progesterone: 0.5 milligram estradiol, 25 to 100
milligrams progesterone. After six rnonths try switching to a tri-est formula to lower the
estrogen-stimulating effect of taking just E2 and get the protective effects of estfiol
E3.

Here the use of estriol and progesterone can be of great benefit. Progesterone and
estriol have been shown to be potentially protective against breast cancer. By monitoring
serum or saliva progesterone levels and urinary estriol levels, a doctor could determine
whether a woman would benefit from this protocol.

Basic Protocol

Estriol and progesterone: 2 to 5 milligrams (equivalent in strength to
0.6 to 1.25 milligrams of Premarin) and 25 to 100 milligrams of progesterone, 2 times a
day, morning and evening.

Some women may escape the ravages of menopause completely. But they find that they need
to go for HRT because of complications from osteoporosis. At this point, estrogen will be
prescribed by a doctor in the form of Premarin/Provera. However, in addition to the
increased risk of cancer and other side effects, this type of prescription commonly brings
on the return of menstruation. Many get quite upset over the fact that they have started
bleeding again every month in their sixties. In addition, this course of treatment is not
the most effective. Many of these women can do very well on progesterone, diet, exercise,
and supplements.

Since both estrogen and progesterone may be needed, a test to determine hormone levels,
followed by regular monitoring, is recommended.